TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Where do you want to start?

(Pause): [00:00:06 00:00:16]

CLIENT: I realize that like when I'm off of my birth control I'm really, really crazy and like super stressed and I was like, 'cause I (cross talk)

THERAPIST: For like a week off or have you stopped taking?

CLIENT: For a week.

CLIENT: Okay. I wanted to get my period before I went to Chicago so I wouldn't get it when I was in Chicago so I was like, 'oh, well, for like the last week I'll just not take it that week and like it actually took a few days longer than normal to get my period and then like when I was like really miserable and stuff and I was just so afraid that like every time because I can't just indefinitely take the pill because like I mean it wouldn't be the end of the world to not get my period but like I, you know they prescribe it such that I have the placebo pill at least every three months and like I run out that way and I don't know what to do because I'm like, this makes me crazy and biologically my hormone levels shouldn't like change that much for the week not having the pills but –

THERAPIST: Can you describe what completely crazy is?

CLIENT: I was feeling suicidal. You say that a lot though. That's not –

THERAPIST: Okay.

THERAPIST: So, tell me what the difference is because that's not the first time I've heard you say you've had suicidal thoughts.

CLIENT: It's not that (unclear) was on and on like every day, like it didn't really go away that much.

THERAPIST: Okay, so they felt more persistent than they usually do?

CLIENT: Yeah and I was crying a lot and just always upset about everything, a lot more than normal and like so far that Sydney was like, 'you should go back on the pill,' and I was like, 'I can't, I need to get my period now,' like, and I did, but like –

THERAPIST: What happens to your mood once your period starts?

CLIENT: I don't know. Maybe it was just really because I was afraid that I wasn't going to get it and just like there is no way in hell I can be pregnant right now but like maybe I'd gained so much weight that I couldn't get my period or something, or, I don't even know – I know weight loss is an issue, I don't know if weight gain is.

THERAPIST: It wouldn't usually be connected.

CLIENT: Okay, so.

THERAPIST: But it might take longer to get it because you sort of stopped taking it somewhat randomly rather than at the completion of a pack.

CLIENT: Yeah, well I mean, that's how it's – well, theoretically at the completion of three packs –

THERAPIST: But is there a difference? I don't know what kind of pill you're taking. Is there a difference in the – like during the pack?

CLIENT: No, they're ones that are the same all through. They're basically – because originally I was on the Seasonique that less you get, you know, everything (unclear) [00:03:01] and is designed for that but when my old insurance wouldn't pay for it then they switched me to something that was like the exact same except not as conveniently packaged and not meant for, like the package, the way the thing is set up is not meant for only getting your period and everything, but it is the same chemical the same throughout and all like one (unclear), different at the beginning and the end. Like I've been on those and they always color those differently, they're all pink except for the placebos are white. So, yeah – (jingling metal)

(Pause): [00:03:34 00:03:39]

CLIENT: And at some point where I was like maybe I should get a hysterectomy or something because that's the only way to guarantee I'll never get my period and therefore never have these hormone fluctuations because I can't really think of anything else that would like do.

THERAPIST: That's a pretty extreme thought.

CLIENT: It is. But I don't want babies. So my uterus isn't actually doing me any good. It's just – like (unclear) of the fact that there are complications and that it would like, you know, I'd have to really, because like so many doctors would be like, 'oh, you might change your mind about kids,' and I'm not changing my mind, especially (unclear). [00:04:18] Yeah, maybe someday I might change my mind like adopting kids but I just don't ever want to be pregnant, so all my uterine system is making me miserable with I guess, they're complications because I'd go through menopause early and stuff so it might make things worse instead of better and I don't really know any way to prevent myself from going crazy when I'm not on birth control pills for a week.

THERAPIST: What were your thoughts like? You said they were more persistent. Were they different in intensity as well?

CLIENT: Un huh. I (unclear) think so. [00:04:56]

THERAPIST: Because I don't feel like you usually tell me that you're crazy.

CLIENT: No, but I just felt like I was being really crazy and irrational, like (unclear) being irrational, like I couldn't stop myself from being irrational.

THERAPIST: So then you're not only feeling irrational, but also frustrated with yourself for not being able to think more logically.

CLIENT: And I guess like, because I was like (unclear) oh, it's not the end of the world and Sydney was like, 'you're not taking this seriously as you should.' I'm like, 'there's nothing I can do about it right now.'

THERAPIST: So what stopped you from acting on the thoughts?

CLIENT: I guess they weren't strong enough to make me actually kill myself.

(Pause): [00:05:37 00:05:41]

THERAPIST: Well, I'm glad for that.

CLIENT: Yeah, they were more (unclear)

THERAPIST: But they just felt more persistent.

CLIENT: Yeah.

(Pause): [00:05:46 00:05:53]

THERAPIST: And this feels similar to like the last time you used the placebo pills and got your period? Or does this feel different?

CLIENT: I don't know because I think the last time I got my – the last time was while I was in the middle of a whole like, I was still on Wellbutrin and that was when I was starting to not work. I think it was in November. Yeah, it was in November and so I was attributing the craziness to being off the placebo, or off the regular pills and so when I was back on the pill things were better. So I guess it was similar to that because there was like, Wellbutrin wasn't working. You know I went back on the pill yesterday so I'm better now but I'm just like really praying for the future because I don't want to have to deal with this like every three months like –

THERAPIST: Well, it sounds like you –

CLIENT: I'm just not functional.

THERAPIST: Yeah, for how many days?

CLIENT: At least a good like four days I think. (Unclear) throughout those fours days, but – maybe it was three days, maybe the first day didn't really affect me that much. I don't really remember (unclear) [00:07:19]

THERAPIST: Yeah, it's hard to keep track when you're feeling so out of your head.

CLIENT: I guess I was feeling for two days because like Sunday, Monday was okay. It was Tuesday afternoon when I was getting – it started like I was sort of freaking out because I went to visit my grandma so me and Sydney drove down and I was like when it was about to, just starting to snow and like I was kind of freaked out on the way down driving in the snow and on the way back there wasn't any snow but I kind of freaked out when I was driving and like then I stopped driving and it didn't go away and it was like that for the rest o the day Tuesday and Wednesday. I guess Sunday and Monday I wasn't bad. It was two days.

THERAPIST: So two days of really intense sadness?

CLIENT: Yeah.

THERAPIST: But also some anxiety in there from driving and how was your visit with Grandma?

CLIENT: It was fine. I mean she's like really losing her memory and stuff and so my parents asked me like, 'oh, did she give you a tour of the place?' Because she moved into the retirement community and I was like she didn't even remember what direction the café was in for lunch, so no.

THERAPIST: What was that like to see her?

CLIENT: I mean I'm sort of used to it like last year when we were in Israel she was forgetting things like if she gave her purse to Dad so she could like go to the bathroom or something then she's like feel panicky that she couldn't find her purse and completely forgot that she had just given it to Dad to hold. So, I'm used to it. Apparently, they have a swimming pool there (unclear) [00:09:06]. "Did she show you the pool?' and like she didn't know where things were. We found our way to lunch just fine but yeah, it was fine, like (unclear) is stressful and I figured you know, whatever, she can ask about my job stuff and I don't really care and she's not going to remember the answer anyway, so I mean I guess it's sad if you're not used to it, so it was not really (unclear) for stress or anything, mostly just the whole like, you know, it was snowing all the way driving down and we were afraid if we were going to get snowed in. But we didn't get snowed in. We were fine.

(Pause): [00:09:44 00:09:50]

THERAPIST: Yeah, it seems to me that it was a little bit more anxious drive.

CLIENT: Yeah.

THERAPIST: On top of not feeling well.

CLIENT: Yeah.

THERAPIST: Kind of unstable.

CLIENT: I mean it must have started like mostly like during driving because otherwise it would have like been too unstable until I think I could go to (unclear) in the first place and I didn't so that's the only reason why I cannot remember that like –

THERAPIST: You don't think you would have embarked on the trip if you were feeling as badly as you recall feeling.

CLIENT: Yeah. I certainly wouldn't have volunteered to drive. So, yeah, it was mostly Tuesday night and Wednesday and Thursday. So, it wasn't that long.

THERAPIST: Was there anything that distracted you from how you felt during the two really bad days?

CLIENT: Yeah, sometimes I could be distracted by watching TV with Sydney or something like he actually, I told him like he should go to therapy last Wednesday, he goes to therapy and he ended up staying and taking care of me because he didn't think I was okay enough to be on my own even though I was like (unclear) to go. [00:11:00]

THERAPIST: So he was really worried too.

CLIENT: Yeah, he was really worried. I think he also wasn't quite feeling up to going to therapy either, but (unclear) [00:11:22]. Yeah, Thursday I felt a little bit better. I guess also Wednesday was sort of hard because I was going to go over to my place and Sydney was going to come with me and that ended up not happening and I was supposed to cook and I ended up having to push everything off and I didn't have clean clothes because I had thought, you know I only packed for through Wednesday and did didn't pack for Thursday so we did end up going to my place like Thursday but you know, I was really over-reacting to that.

THERAPIST: Yeah, what seemed – in actuality was sort of a small change in plans.

CLIENT: Yeah, I wouldn't really though like wearing dirty clothes and I don't know why I couldn't – oh, I guess because I thought it wasn't really safe to drive a car because I was sad and that's why I didn't just go down by myself and come back. It just seemed like it was so overwhelmingly the world, even though it's something I thought we could do.

THERAPIST: And I think that's a big marker, that something felt like the most overwhelming thing in the world when in reality it was quite manageable for you. And that's a place that you find yourself in pretty often. So, for different reasons I've never heard you say before that your period was this, that going, you know, that going off and using the placebo week and getting your period was this traumatic for you. You know you're on the every three month plan to avoid getting your period because I know it's a difficult thing but you've never reported this to me although you have reported kind of feeling like things are a bigger deal than they typically would be. You certainly have had suicidal thoughts in the past so this is kind of a place you go for lots of different reasons.

CLIENT: Well, I guess I thought I was like getting better (unclear) [00:13:14] but then I had a week of just, well not a week but having those few days of feeling horrible, I'm just like there's no way to avoid it as far as I know.

THERAPIST: Like isn't there something you can do to protect yourself knowing that it's a time when you're more fragile and that you tend to react really intensely to things that maybe some of the same skills you use to distract yourself from panic can be things that you put in place ahead of time to protect yourself. There's some things you can do to lessen the effects. You know most people have some sort of emotional reaction to the change in hormones that come along with menstruation whether it's on the pill or not on the pill so being able to set yourself up so that you can cope with some of those emotional swings and some of the physical pain that might accompany it.

CLIENT: Yeah, I was also having physical pain but –

THERAPIST: Yeah and that makes you –

CLIENT: And I'm used to that.

THERAPIST: But it takes energy to cope with that. So making sure that you have things in place to take care of that. I don't know if you can get pain relief, heating pads, Advil, you know, whatever you take that works for you but also things like having something pleasurable to do as a distraction set up ahead of time because when you're feeling really badly it's hard to say to yourself, 'oh, I want to go do this thing' or the other thing, but if it's there already in place, you might do it.

CLIENT: Yes. I'm just having a hard time thinking what kind of things I can do, have set up to do that would make me be able to distract myself.

THERAPIST: I mean you said TV was a distraction so –

CLIENT: It sort of works but not –

THERAPIST: Well, taking the edge off helps.

CLIENT: Yeah.

THERAPIST: So it could be something like if you knew that looking ahead in your pack when you're going to take the next break that a movie date or set up a game night with friends if you know when you're going to take the placebo week. Because you're less likely to back out of those things when you feel badly especially if you tell someone, 'make me go even if I don't want to.' But you're not as likely to set them up and I think if you stay involved and engaged you can thwart some of those thoughts.

CLIENT: I can see myself backing out of those things. You know especially if it requires – you know it's one thing to have people over to my place and it's another thing if I have to like drive. It's another thing if there's snow and stuff.

THERAPIST: Okay. So take down some of those barriers. If you can see that you'd be more likely to follow through if you've invited somebody over, set that up for yourself next time. Make yourself as likely to succeed at helping yourself as possible.

CLIENT: I think the other thing is that they don't last all day and stuff.

THERAPIST: No. It would be a break, you know.

(Pause): [00:16:58 00:17:06]

CLIENT: I feel like I didn't get anything done this week either, I mean I was also like sitting around waiting to find out about [Eventra] (ph) which I haven't yet because like when I've interviewed like two weeks ago Monday they said it would be a week or so, so like the next Monday came and I called Tuesday and they were like, 'oh, we saw that (unclear) a couple of days. Don't worry, we'll call you.' So, it means that I don't think I can call them again and I'm sure they were not open on Friday and I'm pretty sure they may not be open today and like (unclear) (cross talk) [00:17:38]

THERAPIST: Process might have gotten stalled with the storm.

CLIENT: Yeah, they normally like – they're only interviewing four people, total, or something, so –

THERAPIST: It's really hard to wait.

CLIENT: I can but it's like, 'oh, well, I guess I don't have to write cover letters' and then I was like that's really stupid because I should have written cover letters.

THERAPIST: Were there things that would have been interesting to write for?

CLIENT: Some, like I had to [measure tabs open] (ph) which I don't have any more. Make it go back and find all those jobs like there were, you know, really similar (unclear) problems, there was definitely more than one that was something promising that I could apply for. So, yeah –

(Pause): [00:18:20 00:18:27]

THERAPIST: The only thing you can do from here is move forward so if there are things that are still available, you know, still open that you haven't missed the date on, it does make sense to continue to put your application in while you're waiting to hear. Because nothing bad happens if you get the job offer and you've already sent in an application. You don't lose anything other than the time you spent, which, you know, you can't speed up the process.

CLIENT: Yeah. It's just really irritating.

THERAPIST: It's really, I think – I'm wondering if the combination of kind of sitting on edge waiting to hear back from them exacerbated the reaction you had to taking the placebo pills.

CLIENT: Possibly.

(Pause): [00:19:13 00:19:16]

THERAPIST: 'Cause this sounds more intense than what's typical for you.

CLIENT: I'm not sure.

(Pause): [00:19:20 00:19:27]

CLIENT: (inaudible) at least then I'd have something to do during the day.

THERAPIST: If you enjoy it, I mean I really believe that if you're doing something that's interesting to you and that you feel is valuable in some way that those would be good feelings.

CLIENT: Yeah.

THERAPIST: And I know it sounds like the temp job that you tried, one of the real problems with it is that it didn't feel valuable at all so it's hard to convince yourself to go to a place where you didn't really feel that comfortable to do something that wasn't interesting for a reason that didn't feel important.

CLIENT: Yeah. And for not that much money.

THERAPIST: And for not that much money.

CLIENT: Like if I were being paid $100 an hour I could have totally stuck it out.

THERAPIST: That's a pretty high number for a temp job.

CLIENT: It really is.

THERAPIST: For any job.

CLIENT: Yeah, but I mean like, it's the kind of thing (unclear) being paid 20 which would also be pretty high for a temp job but at least it – the pay would be enough to be financially independent. You know I would have held off for longer at least until I finally heard from them if nothing else.

THERAPIST: How did the process of quitting go – this was something you were unsure of?

CLIENT: It didn't go that badly. Like I made the call right after I got done with the appointment with you like to PSG and like they're (unclear) will call you back,' you know. They were like, 'you know, his puts us in an awkward position and I was like, 'well, I'll, if you want me to finish the two weeks or something I can. I don't want to inconvenience anyone but at the same time is job is not like working for me.' And they're like, 'oh, you know especially, oh you know we told you it involved data entry and like, 'yes, but I didn't know that data entry would be this.' Like since I'd never done it before I had no way of knowing that it would be that –

THERAPIST: What it would be like to you.

CLIENT: – miserable. Like I didn't know (unclear) [00:21:17]. So they didn't misrepresent the position, but I guess I overestimated my ability to do it. And so they were like, 'okay, we'll call you back and they never actually called me back so then I ended up (unclear) policy like they did follow their policy but they didn't tell me that they would call me back and so like that was my last day. And my boss goes like pretty understanding about it and like you know, wasn't mad or anything which I was really surprised about but, yeah. (Unclear) two weeks notice. I just wanted to get out of there as soon as I could and then Sydney picked me up so I felt like a lot better after that. [00:21:54]

THERAPIST: Well, I'm glad that helped.

CLIENT: Yeah.

THERAPIST: With some of the stress you were feeling and (unclear) [00:22:13]

CLIENT: Especially if it's like (unclear) but I was working and it was usually – Thursday was really some stress because I was like, wait, what's going to happen when I quit, but usually it's like – it was just mindless but and now I'm still like I think I made the right decision but it's sort of screwed over because they are also saying when I talked to the lady from the temp agency like that, you know, (unclear) we'll worry about what if this happens in the future and I was like, 'okay, I'm completely fine with that consequence like I am looking for jobs in my field. So, like I don't think I can go the temp route any more. I mean I also am just afraid the same thing will happen again and I'm doing something not in my field with lots of hours and not much pay and it's not interesting and stuff. I realize I think I need like something in my field or something that has a much different responsibilities and like the reason I was like –

THERAPIST: Yeah, you should gather information about what kind of environment you need.

CLIENT: Yeah. Because doing the same thing over and over is – there's one thing about data entry because I figured oh, it would be like you know entering things for writing a (unclear) or something but like the difference is the data entered is actually interesting in archives but here it's just like looking up different doctors and their MPI number and putting it into the system and sending it all back to the people which really was not that exciting at all. I mean I wasn't actually doing that much research or anything. Sometimes it took a while to find things but –

THERAPIST: You were clearly unhappy with the position there.

CLIENT: Yeah.

THERAPIST: It sounds like you made the right decision for you.

CLIENT: Yes. I (unclear) and I don't really like (unclear) either it just less stressful than being in a crappy job. [00:24:18]

THERAPIST: So then it makes your next step doing your job while you're unemployed and the job while you're unemployed is –

CLIENT: Getting a job?

THERAPIST: Getting a job. So acting on whatever opportunities are there even while you wait to hear from the other place and you don't have to second guess 'what if's'.

CLIENT: True.

(Pause): [00:24:40 00:24:49]

CLIENT: I really want to be financially independent to be able to get my own apartment some day and I can like have cats because you know I can't have pets in my place because we have a cat and she's crazy and doesn't work out too well with other cats so –

THERAPIST: How are things at the house? You haven't talked much about how things are feeling there.

CLIENT: (Unclear) because Aaron wants to (unclear) his other apartment into a place for like hosting and stuff and so like the remodeling will make it such that only four people can live in the house instead of six but four adults. But like, I was like, 'okay, who's going to leave?' It turns out like (unclear) are going to be the ones who leave because they need – like no other space in the house would work for them, especially like because then they would have (unclear) to his father which basically that wouldn't work so they're going to find something and like they're – Aaron is going to start like, he's going to start looking into it like during winter break which is really soon and like would start the remodeling at the beginning of the summer so I guess you can say it's like going to disrupt the chores and everything else and also there's been a lot like a few times I interacted with him where he's very sad that his (unclear) turns out that he's – and then I realized at the meeting last week that he's actually like done with everyone and is not (unclear) and is really stressed. [00:26:17] So it was sort of a relief to hear that okay it isn't just me.

THERAPIST: Yeah, it's not personal.

CLIENT: Poor Sydney.

THERAPIST: But you were feeling, you were carrying that for a while thinking that he was upset about something.

CLIENT: Yeah. I couldn't even figure out what but it's own stress and I guess the stress was having (unclear) [00:26:41]. I guess it would also be nice to move to a place where there aren't babies because like it really –

THERAPIST: Because it impacted the –

CLIENT: It upsets my (cross talk)

THERAPIST: Baby's older now.

CLIENT: Yeah, 'cause the thing is now he's like played with things and getting crumbs into everything and you know, the high chair has like food spilled over everywhere. When he was feeding (unclear) formula like that was a lot into it but now that can like put food into his mouth he can also put food into places that are not his mouth and like you know, I've not held or pretend at all like since he was a baby. I've only held him twice in his entire life and I'm just like usually like I ever did, like I am the most boring thing ever and there are really interesting things over there. You should go over there. It's like, who knows what's going on in his head. Which is more evident so I really don't want these, like could benefit from not having me (unclear) but yeah, it's like okay.

THERAPIST: So you found it really uncomfortable now that he's older.

CLIENT: I mean he's not around all the time. It's mostly if it's during dinner. And also like getting a pair of slippers for my house is the best thing I could ever do because I'm going down to the kitchen like I don't have to feel like all the ickiness on my bare feet or on my socks and like if I remember to wear my slippers I'm okay.

THERAPIST: That's a really good strategy.

CLIENT: Yeah. Like I don't need things to be spotless and like I don't mean spotless but like I can deal with (unclear) I can't deal with like actual mess and upset. Like a lot of the cleaning up after everything is supposed to be Aaron's responsibility, but like if Aaron's too tired or has a migraine or something it doesn't happen then and it just, yeah, and I really don't like babies and I am fine with the (unclear) of babies as long as they (unclear) but –

THERAPIST: It's very different to live with a baby and to know that they exist in the world.

CLIENT: Yeah. And like it is further reinforcing my decision to never have kids. Like I could handle them if they're like four or five. Once they're potty trained and like realize that it's good to put the food in your mouth and no longer – and the novelty of putting it other places has worn off, like which I think would be when they're four or five or something.

THERAPIST: They're still really messy, gross creatures.

CLIENT: Yeah.

THERAPIST: They're just gross in other ways.

CLIENT: I guess I could handle a teenager. I don't think I could handle kids younger. Yeah, I think I could just –

THERAPIST: You don't have to. There's nothing wrong with not wanting to have children. The only problem with not liking children right now is that one happens to live in your house.

CLIENT: Yeah.

THERAPIST: But there's no rule that says you have to want to be a parent.

CLIENT: No, I'll eventually I'm sure start getting flack from my parents like if Sydney and I get married, but –

THERAPIST: It's still your choice and it's your right to decide that for yourself.

CLIENT: Yeah. I just don't want kids. I guess my parents are like you know, because theoretically Cullen can have children and Cullen and Doreen probably will have children because Doreen wants children. But, my parents are also big on how they want Jewish grandkids and Cullen and Doreen's children will not by default be Jewish, so I might still have had a lot of guilt because (unclear) after my grandfather right now and –

THERAPIST: You might. Your parents' wishes – you have no control over what their wishes and wants are. That does not mean that there's something wrong about not having the same ideas as them. When that time comes you have to work on finding a way to be okay with your own choice.

CLIENT: (Unintelligible) I can be like, 'sorry, it's a done deal.' Well, I mean I guess that's true.

THERAPIST: That's true but that's an extreme – that's a big surgery and an extreme reaction to somebody questioning whether or not you're going to have kids.

CLIENT: Isn't that it will also help with the not having a period thing.

THERAPIST: It might.

CLIENT: Or would it make things worse?

THERAPIST: But forced immediate menopause is not going to be pleasant either.

CLIENT: Okay. I feel like I don't really have any choice.

THERAPIST: Well, but let's track what happens next time. I think basing your decision on this time it seems like your reaction, your emotional reaction to having your period was really intense.

CLIENT: Yeah.

THERAPIST: But I think we should pay some attention to what happens the next time and see if there's any ways we can somehow ameliorate some of the intensity. Because I'm really hopeful that there are things less extreme than having a hysterectomy that make it more manageable for those couple of days. Or at least if this is even the pattern that it's this intense. You know, like I said, I was surprised to hear you say that your suicidal thoughts were so persistent because it's not something you've brought up in the past – which doesn't mean it didn't happen – but it wasn't something that was so present for you that it was what you came into session with. So I think we should track it and see what really is your response – is that intensity atypical for you? Are there things we can do to make it less intense if it continues to feel that bad?

(Pause): [00:32:18 00:32:26]

CLIENT: I really don't know.

THERAPIST: Yeah, so we really need to mark it down when you're expecting to take a placebo week again so we can really pay attention to what's going on.

CLIENT: I mean it will be in two or three months, so not for a while.

THERAPIST: So let's be prepared and let's pay attention to what your response really is.

(Pause): [00:32:48 00:32:54]

CLIENT: Because like I know the hormonal IUD is like, I've heard that those can be bad with depression.

THERAPIST: As well as can the pill.

CLIENT: Yeah, so I don't know if things will just make it worse so also getting an IUD would be really bad for it, or if possible, possibly, so I don't really want to deal with that but I'd rather like, I can remember to take the pill every day since I have to take the other pills, so I feel like that's a huge reason why people end up going with an IUD is like because it might be more effective as a birth control strategy whereas I'm mostly thinking of help for like for my hormones and my depression, so –

THERAPIST: Well, so there are also other hormonal methods. So if this continues to be as big of a problem, you know, having some conversations with your gynecologist about if there are other options for you, other hormonal options that might give you some benefit without this side effect then I think we really need to see what – we can't make big decisions based on this one really negative experience. Because in some ways this has worked really well for you, it sounds like.

CLIENT: Yeah. Whenever I don't have my period I'm fine.

THERAPIST: Yeah. That's a lot of the time.

CLIENT: Yeah.

THERAPIST: How has exercise been? I'm assuming the storm got in the way a bit.

CLIENT: Yeah. Like we've been – we did go on Thursday night for a little bit. Also on Tuesday afternoon we ended up walking around for a good hour.

THERAPIST: I know when I saw you last you had discovered that new game –

CLIENT: Yeah. That's what we did.

THERAPIST: Great.

CLIENT: And I even got here a little bit early and was walking around in the snow –

THERAPIST: Sloshing around out there.

CLIENT: Yeah. It's really scary because I, like there are a [few distress charges of areas] (ph) like that aren't shoveled that well like ice and I feel like I'm going to fall because I've like nothing to hold onto so yeah, so it's still too snowy to like – and like we had originally thought, 'oh, maybe we'll go on Friday night,' like in the snow and it didn't happen which was really –

THERAPIST: Seemed like a cold, windy snowstorm.

CLIENT: Considering how bad it was like today and this is even better than – it's not as bad as it was, like, I'm like, 'okay, I made the right decision to not go out.' And like yesterday I was supposed to have auditions for – yeah, I was like planning on getting there like 45 minutes early and then auditions were cancelled because of the snow.

THERAPIST: Yeah, you made some safe decisions with the storm and just even visibility is not really good with all the high snow banks.

CLIENT: Yeah, that's true.

THERAPIST: Cars can't necessarily see people. Sidewalks aren't necessarily cleared.

CLIENT: Yeah, so I'm – but we do have to go out. Like tonight we have rehearsal and possibly auditions if people can audition today so I might get there early and stuff but I don't – so it's working in as much as the weather is like not stopping us.

THERAPIST: Where you can't control what happens with the weather. But I'm wondering too if that might help. Exercise is often a really good mood lifter and can help just to change your baseline. So just as it helps you can lift your mood on a regular basis using exercise specifically targeted to when you're expecting your period, can help to offset some of that upset so you're not being able to get out as much and so as much aerobic exercise and the walking is really good aerobic exercise. So you didn't have that as much as you could have.

CLIENT: Yeah, there's nothing I can really do to control the weather though.

THERAPIST: There's absolutely nothing you can do to control the weather.

CLIENT: Yeah, and walking is one of those things that is impacted by weather.

THERAPIST: Yeah, so just knowing – I'm not critiquing that you were unable to do it. I'm saying that knowing that that's one thing that could have helped had you had access. So next time around it's unlikely to be a giant snowstorm because it will be a lot closer to real Spring so making sure that that's a time when you do get out and walk or go out and dance – same thing.

CLIENT: Yeah.

(Pause): [00:37:44 [00:37:50]

CLIENT: I guess it's also, I mean Sydney is getting better with his depression and like wanted to go out but sometimes he still doesn't want to go out either. I go out by myself or I don't.

THERAPIST: And if he doesn't want to go, you do go out by yourself. That's the healthiest choice for you and it's great when he can join you and also make a good choice for himself but I think one of the things about you feeling better is not being reliant upon him to join you. You making good decisions for you even when he can't. It gives you a lot more freedom to have that independence.

CLIENT: I should be better about that but the snow got in the way of everything.

THERAPIST: The snow was bigger than you.

CLIENT: Those piles are taller than I am. Some of them are at least. Yeah there's really nothing I can do until the weather gets better. It's going to take a while for all the snow to like clear out of the way I think.

THERAPIST: It will. Hopefully, sidewalks will be more cleared though and people will continue to – cities and towns will continue to try to clear sidewalks so that – you know, the snow banks are going to be there for a long time but there should be clear pathways.

CLIENT: If I had a (unclear) [00:39:11] I could get rid of the snow banks.

THERAPIST: That would help.

CLIENT: (Laughs) I really [thought a playther] (ph) are going – I think they're kind of illegal for a civilians to have. [00:39:19] As far as I know.

THERAPIST: I think you're going to have to wish on that one for snow banks to disappear.

CLIENT: It like they have nowhere to go so they just pile everything up more.

THERAPIST: Yep, that's true.

CLIENT: It's also like how am I able to get to rehearsal if I'm not going to have a place to park and everything is all snow.

THERAPIST: (Unclear) parking is really hard.

CLIENT: I guess I'll splurge on cabs because –

THERAPIST: Yeah, that might be a good choice because parking is really very limited so even if you go it might be really frustrating to try to find a safe place to park.

CLIENT: Yeah.

THERAPIST: So this is a good time to splurge on a cab and to be in the back of the car wearing your seatbelt.

CLIENT: Yeah, I guess. It's just so awful out there. I'm sure that's (unclear) unable to (unclear). [00:40:09]

THERAPIST: Yeah, it's pretty gray. And that's another thing so this is a good time to use your lamp.

CLIENT: Yeah.

THERAPIST: All those things you have. All those little tricks you have that you know work a little that don't erase it but they work a little to add them all together. So use what you can. So you can use your sun lamp, you can make it easier to get someplace and be social undistracted. You can do some stretching, or some exercises in your room since it's harder to walk around. These are all little things you can do. And you can get an application out so you can feel good about that. Go back to that goal of getting one out a week.

CLIENT: I can do that.

THERAPIST: And then you can feel good about having checked off that box.

CLIENT: When you consider that I got interviewed from something that I thought was a real long shot I guess I can find other things that are long shots, too.

THERAPIST: Absolutely, because that – yeah. That one worked.

CLIENT: Yeah.

THERAPIST: To some degree. You know we don't – I would love to hear that you got a job offer, but you did get an interview and you didn't think you were going to.

CLIENT: Yeah. I hope I get it but.

THERAPIST: Me too.

CLIENT: The interview would be kind of hard but that's okay.

THERAPIST: Well, I'm hoping for you. I would love to hear that good news for you.

CLIENT: Yeah.

THERAPIST: Let's take a minute to schedule because you don't have anything scheduled and I know that if you hear something from them we'll have to reschedule it but just to have something in the books.

CLIENT: Yeah. If I get the job like do you have slots on Friday because I thinking of not working Fridays.

THERAPIST: Friday is a very popular day but let's see.

CLIENT: (Unclear) there might be like either Mondays or Tuesdays because I'd only work three days a week.

THERAPIST: So right now I have an every-other-week spot open on Friday mornings at 11:30. I have Monday afternoon still open and I have Tuesday an every-other-week spot at 3:30. So I'll have to see –

CLIENT: I'll probably just stick with Monday so if I get the job I could just work Tuesday, Wednesday, Thursday.

THERAPIST: Okay.

CLIENT: Yeah.

THERAPIST: And have your Mondays and Fridays open. And the other thing we can do is if we have to flip-flop around we can do that.

CLIENT: Okay.

THERAPIST: So for next week, well, Monday is President's Day so probably even if you got the job you wouldn't be working then.

CLIENT: That's true.

THERAPIST: I can offer you an 11:30 or 2:30.

CLIENT: I'll put the 2:30 on my calendar.

THERAPIST: So that's the 18th. And do you want to put that on the calendar the next week too or would you prefer to hold off on that?

CLIENT: Sure, I could do that.

THERAPIST: So I'll just hold that free and the 2:30 on the 25th as well. And I still have not heard anything back from your insurance company so I will check in with them because I feel it's been a while now. Maybe there will be something in the mailbox today.

CLIENT: Okay.

(Pause): [00:43:33 00:44:19]

THERAPIST: Okay? So obviously just call me if we need to reschedule and I guess I just also want to remind you that since you did have more frequent suicidal thoughts if you ever feel like you're going to act on that or have a specific plan you call the ER or get yourself to the ER right away. I know generally you're able to have the thoughts separated from whether or not you're actually going to act on it but if it ever feels like you can't stop yourself or if you really are thinking about following through and hurting yourself keep yourself safe.

CLIENT: Okay.

THERAPIST: I will see you next week.

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